Zygomatic Implants

When you read the numbers on this page, you need to know the limits of the evidence behind them. There is little research on zygomatic implants.

• Randomised evidence is limited to two small trials. A 2026 Cochrane review found two trials with 71 and 20 participants¹, each followed for three years. The two trials do not ask the same question. The 71-participant trial compared zygomatic implants with conventional implants placed after bone grafting. The 20-participant trial compared two surgical methods of preparing the site for a zygomatic implant. So only one randomised trial assesses the grafting alternative. The certainty of the evidence was rated moderate to low. Because the samples are small and the confidence intervals wide, the findings cannot be carried over to clinical practice with confidence.
• The rest of the evidence is observational. The survival figures come from two reviews of 18 studies each: one compared zygomatic implants with conventional implants², the other pooled long-term outcomes³. Patients in these studies were not randomly allocated; which patient was given which method may have affected the results.
• There is no grading of the evidence. The observational reviews were not graded with GRADE.
• Averages are not one clinic's results. Published rates are averages of studies from different countries, different patient groups and different years.

That is why, next to every rate on this page, we say which study it comes from and what was counted. The evidence we have cannot support a claim that one route is clearly better than, or equivalent to, the other.

Where it may be considered

• Bone loss in the upper jaw is advanced and a standard implant cannot be placed. The patients in the trials of the Cochrane review had a severely resorbed upper jaw in which conventional implants could not be placed¹.
• The bone grafting route has been assessed, and the patient and dentist have decided against it.
• General health allows surgery of this extent and anaesthesia.

Who it is not for

• Patients with enough bone in the upper jaw to hold standard implants. A zygomatic implant is more extensive surgery that reaches the cheekbone, and these patients do not need it.
• Patients with untreated sinus or nasal disease. These problems are assessed first and, where needed, managed together with an ear, nose and throat specialist.
• Active infection, untreated gum disease, uncontrolled general illness. These are dealt with first.
• General health that does not allow surgery or anaesthesia.
• A jaw that is still growing. In young patients, implants are postponed until growth is complete.

What increases the risk

The figures below are for implant treatment in general and are pooled results of observational studies; they show an association and do not establish cause.

• Smoking. In people smoking more than 20 cigarettes a day, implant loss was about 2.5 times as likely per implant⁴ as in non-smokers. No safe number of cigarettes has been shown.
• A history of gum disease. Across 14 prospective studies, the risk of implant loss was about 1.75 times higher⁵.
• Clenching or grinding. In 27 studies, the odds of implant loss were about 2.2 times higher⁶ (an odds ratio).
• Bone-strengthening medicines (bisphosphonates, denosumab). A 21-study review found that in people taking bisphosphonates, implant loss was about 1.7 times more likely per implant⁷. Per patient, the risk of medication-related death of jaw bone (osteonecrosis) was about 3.5 times higher. In the per-patient analysis of implant loss there was no significant difference. These figures apply to bisphosphonates and cannot be generalised to denosumab. At the high doses used in cancer treatment, implants are often not appropriate; doses used for osteoporosis are assessed separately. The certainty of the evidence is very low. Always tell your dentist about your medicines, and do not stop a medicine without asking the doctor who prescribed it.
• Diabetes, radiotherapy to the head and neck, and other medicines also change the plan. These factors are covered in detail on the All-on-6 page.

Routes to discuss first

• Bone grafting and sinus lift. If the bone can be built up, the standard implant route may open up. This route takes longer and has its own risks.
• A removable full denture. It needs no surgery and is a reversible option.
• A different fixed design. If the bone allows, All-on-4 or All-on-6 may come into consideration; we compare the options on the full-mouth implants page.

The decision is made on a 3D scan and your medical history, with an ear, nose and throat assessment where needed.

The sequence below is the usual course of this treatment. Times and details vary from patient to patient; your plan is given in writing.

Risks

• Sinusitis. Sinus inflammation is the most commonly reported biological complication of zygomatic implants. In an estimate pooled from 11 studies with a mean follow-up of 65 months, it was reported in 14.2 per cent of patients³. The rate ranges from 2.8 to 36.4 per cent across studies, and the methods of diagnosis differ. The authors point out that chronic sinusitis affects more than 10 per cent of people in western populations even without implants. This figure is not an individual patient's risk.
• Infection and a connection between the mouth and the sinus. After sinusitis, the most commonly reported problems are infection and an opening forming between the mouth and the sinus². Sinusitis has mostly been associated with the technique in which the implant passes through the sinus.
• The complication trade-off. In a single randomised trial, zygomatic implants led to fewer implant losses but more complications¹ than conventional implants placed after bone grafting. The odds ratio was 4.53 for complications and 0.23 for implant loss. Both findings are of moderate certainty and belong together.
• Implant loss. In an observational review, implant loss was 0.7 per cent a year³ per implant. What is done if an implant is lost depends on the patient, and further surgery may be needed.
• Changes in sensation (neurological complications). Numbness or altered sensation in the cheek, under the eye or in the upper lip can occur; it is usually temporary and rarely permanent. The same review gives the rate of implants that stayed in place with no biological or neurological complication as 95.7 per cent³; in other words, these complications were counted and did occur. The sources we have do not give the frequency of each of these complications separately.
• Inflammation around implants. Peri-implantitis is inflammation of the tissue around an implant with loss of the supporting bone. The sources we have give no rate specific to zygomatic implants; in implant patients in general, a 57-study review found it in about 20 in 100 patients⁸.
• Problems with the bridge. In the observational review, 94 per cent of bridges³ were in use. Technical problems such as screw loosening and chipped porcelain are common with full-arch bridges⁹.
• Risks of surgery and anaesthesia. Bleeding, swelling, bruising, infection and risks related to anaesthesia apply to this surgery too. The method of anaesthesia and the setting should be written in the plan.

Benefits

• A fixed bridge without bone grafting. In the single randomised trial, the time until a working fixed bridge was fitted averaged 444 days on the grafting route and about 1.3 days¹ with zygomatic implants. This does not mean "teeth in a day". What was compared is not the length of an appointment but the overall time of two treatment routes. A bridge fitted early may be temporary; this time does not show that integration or the final bridge treatment has been completed. The result comes from a single trial with 71 participants.
• Reported survival. In an 18-study review that included at least five years of follow-up, about 96.5 per cent² of implants were reported to be in place; the rate for conventional implants in the same studies was 95.8 per cent. The review does not tie this rate to a single follow-up period. No comparison found a significant difference. These studies were not randomised, so they do not count as evidence of equivalence.
• We cannot say anything about patient satisfaction. The satisfaction measure in the single trial is of low certainty and at high risk of bias; no claim about satisfaction can be drawn from it.

The first days

• Swelling and bruising increase over the first two to three days, then settle; use cold packs and the medicines prescribed.
• Soft, lukewarm food for the first weeks. While the temporary bridge is in, do not chew hard or sticky foods.
• Your dentist will give you written precautions to protect the nose and sinus area, such as not blowing your nose hard.
• If you had sedation or anaesthesia, do not drive or operate machinery for as long as the team tells you. The UK national standard for conscious sedation in dentistry requires an escort. This applies to every form of sedation other than inhalation sedation in adults¹⁰. For deep sedation and general anaesthesia, the anaesthesia team gives the discharge rules.
• Smoking impairs healing; at the least, avoid it during the healing period.

Daily care

• Clean under the bridge every day with bridge floss, interdental brushes or a water flosser. Your dentist will show you which works for you.
• Brush twice a day with a soft brush and fluoride toothpaste, paying particular attention to the line where the gum meets the bridge.
• When the bridge is completed, an X-ray and probing measurements are taken as a baseline¹¹; these records allow later changes to be compared reliably. Without a baseline, assessment relies on other diagnostic criteria.
• At reviews, you are also asked about sinus symptoms (nasal discharge, a blocked nose, fullness in the face).

Staying in the mouth does not mean being trouble-free. The rates below come from observational studies; they are not randomised, and there is no such thing as a treatment "for life".

• Implants. In an 18-study review that included at least five years of follow-up, about 96.5 per cent² of zygomatic implants were reported to be in place (per implant).
• Six-year follow-up. In another review, about 96.2 per cent³ of implants were in place at six years, and 94 per cent of bridges were in use.
• Maintenance. Being in use does not mean no repair was ever needed. Tightening screws, repairing the bridge and renewing it over the years are normal maintenance; ask about the cost of these in advance.

Contact your dentist after surgery, or while you are using the bridge, if any of the following happens:

• Pain or swelling that increases after the third day; bleeding that does not stop
• Nasal discharge on one side, a blocked nose, a bad smell, or fullness in the face and sinus pain
• You notice liquid or air passing from your mouth into your nose
• Numbness in the cheek, under the eye or in the upper lip that does not go away
• The bridge moves, a screw feels loose, or a piece cracks or breaks
• Bleeding, pus or receding gum around the bridge

Emergencies. Difficulty breathing or swallowing, rapidly spreading swelling of the face or neck, a high fever or swelling around the eye are serious signs. If you have any of them, do not wait for the clinic's reply. Go to the nearest emergency department or call 112.

Fees are not given on this page. The main factors that shape the plan are:

• The number of implants and the design
• The method of anaesthesia and the setting
• The type and material of the temporary and final bridges
• An ear, nose and throat assessment and any treatment needed first
• The number of visits and the review programme
• The conditions for remaking if there is a complication

Ask for the plan in writing, including what it covers. The plan should also state who pays for further treatment if there is a complication.